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Be aware how your voice works. Have you ever pulled the open end of an air filled balloon tight and the air rushes out at a squeal like pitch, then the more you open the balloon, the quieter and lower the pitch gets. This is a literal representation of your vocal chords.
The surgery can affect their ability to sing and even change their vocal range. Julie Andrews and Ryan Key both lost the majority of their ability to sing after they had vocal cord nodule surgeries. General anesthesia is administered first. For manual removal of the nodules, scalpels and surgical scissors are used.